Similar cancer incidence in RA patients treated with tocilizumab or TNF inhibitors
Patients with rheumatoid arthritis have a similar incidence of cancer regardless of whether they are treated with tocilizumab or tumour necrosis factor (TNF) inhibitors, according to a study presented at EULAR 2018.
“This study found no difference in the risk of malignancy, excluding non-melanoma skin cancer, in patients with rheumatoid arthritis who newly switched to tocilizumab versus TNF inhibitors from a different TNF inhibitor, abatacept, or tofacitinib,” said study lead author Associate Professor Seoyoung C. Kim from Brigham and Women’s Hospital-Harvard Medical School in Boston, Massachusetts, US.
Using data from three US healthcare claims databases from 2010 to 2015, researchers identified patients aged ≥18 years with rheumatoid arthritis who had recently initiated treatment with tocilizumab (n=10,393) and propensity score matched them to patients who had recently initiated treatment with TNF inhibitors (n=26,357) following treatment failure with abatacept, tofacitinib, or a different TNF inhibitor.
Patients were followed-up until treatment discontinuation, outcome incidence, disenrollment, death, or end of study. Over the study period, 118 malignancies developed among patients who initiated tocilizumab and 322 among patients who initiated TNF inhibitors.
The incidence rate of malignancy ranged from 0.81 to 2.18 per 100 person-years among patients who initiated tocilizumab and 0.98 to 2.16 per 100 person-years among patients who initiated TNF inhibitors. [EULAR 2018, abstract OP0002]
Patients who initiated treatment with tocilizumab had a comparable risk of incident cancer with patients who initiated treatment with TNF inhibitors across the three databases (hazard ratio, 0.92, 95 percent confidence interval, 0.74–1.14).
Analyses according to cancer subtype (pertaining to the 10 most commonly occurring cancers [breast, colorectal, bladder, kidney, lung, thyroid, prostate, and uterine cancer, melanoma, and non-Hodgkin’s lymphoma] as well as leukaemia and human papillomavirus-related cancers) revealed similar results to the main finding.
“Our study is one of a few to investigate head-to-head comparisons of malignancy risk between different types of biologics in rheumatoid arthritis,” said Kim.
“The risk of malignancy among patients with rheumatoid arthritis has been of ongoing interest,” said Professor Robert Landewé, Chairperson of the EULAR 2018 Scientific Programme Committee. “With more biologic treatment options available and earlier initiation of therapy, it is important to understand the risk of malignancies in patients with rheumatoid arthritis,” he said.